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Page 6 PLEASE TYPE OR PRINT ALL INFORMATION STATE ASSIGNED LICENSE NUMBER 0252 _ 44 _ 005 _003 ALL APPLICANTS ANSWER THE FOLLOWING 6.1 HAS THE APPLICANT EVER BEEN DENIED A LIQUOR LICENSE IN NEW JERSEY? Yes XX No IF THE ANSWER TO THIS QUESTION IS"YES,"ANSWER THE FOLOWING: Type of License or Permit Denied: Retail Wholesale Transportation Warehouse Manufacturer Unit of Government which denied License or Permit: Date of Denial(approximate if not known) / / Reason for Denial 6.2 HAS ANY CORPORATION,PARTNERSHIP OR INDIVIDUAL MENTIONED IN THIS APPLICATION,OTHER THAN THE APPLICANT, BEEN DENIED A LIQUOR LICENSE OR PERMIT? Yes XX No IF THE ANSWER IS"YES,'ANSWER THE FOLLOWING: Name of Entity Last Name First Name Middle Initial Type of License or Permit Denied: Retail Wholesale Transportation Warehouse Manufacturer Unit of Government which denied License or Permit: Date of Denial(approximate if not known) I I Reason for Denial 6.3 HAS THE APPLICANT OR ANY OTHER PERSON, CORPORATION OR ENTITY MENTIONED IN THIS LICENSE APPLICATION, OR ANYONE WITH A BENEFICIAL INTEREST IN IT, HAD AN INTEREST IN A NEW JERSEY ALCOHOLIC BEVERAGE LICENSE WHICH WAS SURRENDERED,SUSPENDED OR HAD A PENALTY IMPOSED IN LIEU OF SUSPENSION,NOt. ENEWED,REVOKED OR CANCELLED WITHIN THE 10 YEARS PRIOR TO THE DATE OF THIS APPLICATION? yes No IF THE ANSWER IS"YES,"PROVIDE DETAILS OF EACH BELOW[Complete a separate Page 6 for each action]: Name of Individual Cherry Hill Wine & Spirits Inc. • Last Name First Name Middle Initial DATE OF ACTION 01 ,/ 01 / 1997 DOCKET NO. 06028-965 PENALTY WAS IMPOSED BY: Division of ABC [Indicate whether by Division of ABC or identify Local Issuing Authority] PENALTY CONSISTED OF: XX FINED $ 10,000.00 NOT RENEWED `amount] XX SUSPENDED ONE DAY REVOKED CANCELLED (number of days) OTHER[explain] 6.4 HAS THE APPLICANT OR ANY OTHER PERSON OR CORPORATION MENTIONED IN THIS LICENSE APPLICATION, OR ANYONE WITH A BENEFICIAL INTEREST IN THE BUSINESS UNDER LICENSE OR TO BE LICENSED,EVER BEEN CONVICTED OF A CRIMINAL OFFENSE? Yes XX No A. IF THE ANSWER IS"YES,'ANSWER THE FOLLOWING: Name of Individual Last Name First Name Middle Initial Date of Birth / / Conviction Date / / State _ Court of Jurisdiction Description of offense(specific charge) Disposition(fine,penalty,etc.) Nature of interest in entity to be licensed B. If applicable,provide the date the Director of the N.J.Division of Alcoholic Beverage Control issued an order approving or disapproving disqualification removal: / / . (No license may be issued without an order from the Director of the Division of Alcoholic Beverage Control determining no disqualification or removing disqualification.) (See R.S.33:1-31.2 and N.J.A.Q.13:2-15.) Provide Agency Docket No. :[NN]-,